Parkinson’s Disease and Acid Reflux

Many people have heartburn, or its more severe condition called gastroesophageal reflux (acid reflux).Heartburn is a concern for many people with Parkinson’sHeartburn is a concern for many people with Parkinson’s People with Parkinson’s disease, however, are especially prone to acid reflux. Why? To understand its cause, we need to know a little about the gastrointestinal tract (GI tract).

When food is swallowed, it moves down the throat until it reaches a valve called the esophageal sphincter. This valve remains tightly closed, only opening up to allow food to pass through into the stomach. Its job is to keep food down in the stomach where it can be prepared for digestion.

Once food arrives in the stomach, special muscles begin grinding it into a paste. This paste of tiny food particles is then mixed with acids and other chemicals before moving on to the small intestine.

A strong lower esophageal sphincter acts as a one-way valve at the top of the stomach to keep food and fluids down.

How does Parkinson’s disease change the action of the GI tract?

Parkinson’s disease can change these processes. The nerves that guide the muscles of the GI tract may be slowed, and this slows the muscle action as well. The stomach takes longer to grind and mix the food. When food and stomach acid sit in the stomach for too long, the acid acts on the food to form gas, which can distend the stomach, causing burping, and sometimes severe bloating and painful cramping.

Also, the esophageal sphincter may be weakened, so that it’s harder for it to stay closed properly. This means that stomach acids, gas, and food may be pushed upward against the sphincter, causing a feeling of “fullness.” If the sphincter becomes too weak, it can be pushed open, allowing acids to come up into the throat, and producing a burning feeling. This is acid reflux.

A weak esophageal sphincter does not close off the top of the stomach; this allows foods and fluids to wash back up, or reflux, into the esophagus.

Why is acid reflux a problem?

The throat and esophageal sphincter have a delicate lining. The powerful stomach acids can eventually lead to permanent scarring. The sphincter may become deformed and unable to close.

The throat scarring can lead to a precancerous condition. The individual will have increasing difficulty with swallowing, more frequent reflux, and may even develop cancer.
Stomach acids and/or food may be inhaled into the lungs. The lungs provide a warm, moist environment. Food particles, warmth and moisture provide perfect conditions for bacteria to breed. This leads to infection and pneumonia. Hospitalization for pneumonia is not uncommon in people with PD.
Controlling bloating and acid reflux

To avoid these problems, it’s best to control bloating and acid reflux before they can cause damage. Certain foods are more likely to trigger reflux; avoiding these foods can help. Foods that can trigger reflux include alcohol, tomatoes, citrus fruits, caffeine, chocolate, and peppermint. Other foods may be trigger foods for you, though — different people are affected by different foods. Keeping a record of foods eaten can help you detect which ones are a problem for you.

Large meals can also lead to bloating and reflux, because the stomach needs more time to process a lot of food. The large meal will stay in the stomach longer, and increase the likelihood that gas will form, and produce upward pressure against the esophageal sphincter.

A meal high in fat will also stay in the stomach longer, because fat takes more time to empty from the stomach than carbohydrate or protein. It’s usually fine to eat fatty foods; however, portions should be small so that they can clear the stomach quickly.

If you’re troubled with reflux, pay close attention to your personal “trigger foods” – those that trigger an attack. Avoid those foods whenever possible. For both bloating and reflux, try to eat smaller meals and eat more frequently. Instead of three large meals daily, aim for five or more smaller meals and nutritious snacks. Or, you can eat half your meal, wait an hour or so, then eat the other half.

Example: If your usual breakfast is juice, cereal with milk, and toast, eat the cereal, wait at least an hour, then have the toast and juice.

For difficulty with bloating and acid reflux, ask your physician for a referral to a registered dietitian who specializes in diet for Parkinson’s disease. Dealing early with acid reflux can help you prevent such problems as pneumonia, scarring,and hospitalizations later on.

If you have any questions or thoughts, put them in the “Comments” section on this page, and I’ll respond. I hope to hear from you.

Barbara, I am sorry I overlooked your comment. Diet may well depend on the cause of the diarrhea. Diarrhea with PD is often due to Irritable Bowel Syndrome, and this you should discuss with your doctor — perhaps ask for a referral to a gastroenterologist as well. It may also be due to Small Intestine Bacterial Overgrowth (SIBO), an infection that can occur in the intestines. This is especially likely if gastroparesis (slowed stomach emptying) is present. Again, your doctor needs to refer you to a gastroenteroenterologist for a diagnosis. Finally, if you are usually constipated, but have started noticing diarrhea, it can be a sign of bowel impaction. Slowed movement of the colon means the stool stays in one place for too long, while water is constantly being withdrawn. This leaves a dry hard stool accumulation that is difficult-to-impossible to pass. Watery stool may then pass around the impacted stool, leading to the belief that the person actually has diarrhea instead of constipation. Signs of impaction include a swollen, painful abdomen. If this is a possibility, see your doctor immediately as it can become very serious, even requiring hospitalizaation. Let me know if this did not answer your question, and if you have learned the cause of the diarrhea, because diet for IBS/diarrhea can be quite different for that of SIBO or bowel impaction.

Hi , my wife is waking up at night crying from the pain of acid reflux recently. She is not getting proper rest the past week. It seems as if anything she eats contributes to her issues which may be the valve just not working. We bought a wedge to put under the mattress but that does not seem to work. She is now sitting in a lazy boy to help and is very distressed about what to do. She is taking antacids (tums) and nexium daily. What can she do to get out of this current crises?

Rick, can she note whether certain foods cause the reflux? Foods high in fat tend to be more of a problem; but also, some people react to specific foods, like chocolate, or some fruits, or tomatoes. Also, has she tried eating just small amounts of food, to see if that makes a difference? Sometimes dividing three meals a day into five or six smaller portions helps because the stomach doesn’t have to work as hard.

Be wary of antacids, because if the stomach acid is neutralized, it can lead to deficiency of vitamin B12 and other nutrients that need acid for absorption. If none of these suggestions help, she needs to ask her primary care physician for a referral to a gastroenterologist. This specialist can determine the reason for the constant reflux. Dealing with it early can prevent scarring of the esophagus. Let me know if this helps, and let me know how she is doing. My very best to you both.

6/11/17 – For regurgitation, here is a quote I just came across, from a physician, Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia. “How about using LINX® (Torax Medical; Shoreview, Minnesota), the stretchy magnetic bead “bracelet,” for reflux? This magnetic sphincter augmentation has been well studied in primary gastroesophageal reflux disease (GERD) using the endpoint of heartburn. Bell and colleagues[5] looked at this using the primary endpoint of regurgitation. After 6 months, 92.6% of patients had improvement in regurgitation with LINX compared with 8% of those taking PPIs. We do not do very well using PPIs for regurgitation. LINX seems to be emerging as a nice option for people with regurgitation.” Rick, I’m not familiar with this procedure, but I think it would be worthwhile to ask your wife’s gastroenterologist about it, as she is in so much pain. Let me know how she is doing. -Kathrynne